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Human resources and models of mental healthcare integration into primary and community care in India: Case studies of 72 programmes

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  • Nadja van Ginneken
  • Meera S Maheedhariah
  • Sarah Ghani
  • Jayashree Ramakrishna
  • Anusha Raja
  • Vikram Patel

Abstract

Background: Given the scarcity of specialist mental healthcare in India, diverse community mental healthcare models have evolved. This study explores and compares Indian models of mental healthcare delivered by primary-level workers (PHW), and health workers’ roles within these. We aim to describe current service delivery to identify feasible and acceptable models with potential for scaling up. Methods: Seventy two programmes (governmental and non-governmental) across 12 states were visited. 246 PHWs, coordinators, leaders, specialists and other staff were interviewed to understand the programme structure, the model of mental health delivery and health workers’ roles. Data were analysed using framework analysis. Results: Programmes were categorised using an existing framework of collaborative and non-collaborative models of primary mental healthcare. A new model was identified: the specialist community model, whereby PHWs are trained within specialist programmes to provide community support and treatment for those with severe mental disorders. Most collaborative and specialist community models used lay health workers rather than doctors. Both these models used care managers. PHWs and care managers received support often through multiple specialist and non-specialist organisations from voluntary and government sectors. Many projects still use a simple yet ineffective model of training without supervision (training and identification/referral models). Discussion and conclusion: Indian models differ significantly to those in high-income countries—there are less professional PHWs used across all models. There is also intensive specialist involvement particularly in the community outreach and collaborative care models. Excessive reliance on specialists inhibits their scalability, though they may be useful in targeted interventions for severe mental disorders. We propose a revised framework of models based on our findings. The current priorities are to evaluate the comparative effectiveness, cost-effectiveness and scalability of these models in resource-limited settings both in India and in other low- and middle- income countries.

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  • Nadja van Ginneken & Meera S Maheedhariah & Sarah Ghani & Jayashree Ramakrishna & Anusha Raja & Vikram Patel, 2017. "Human resources and models of mental healthcare integration into primary and community care in India: Case studies of 72 programmes," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-25, June.
  • Handle: RePEc:plo:pone00:0178954
    DOI: 10.1371/journal.pone.0178954
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    References listed on IDEAS

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    1. Mendenhall, Emily & De Silva, Mary J. & Hanlon, Charlotte & Petersen, Inge & Shidhaye, Rahul & Jordans, Mark & Luitel, Nagendra & Ssebunnya, Joshua & Fekadu, Abebaw & Patel, Vikram & Tomlinson, Mark &, 2014. "Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and U," Social Science & Medicine, Elsevier, vol. 118(C), pages 33-42.
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    Cited by:

    1. Mirza, Arshad & Singh, Nirvikar, 2018. "Mental Health Policy in India: Seven Sets of Questions and Some Answers," MPRA Paper 91046, University Library of Munich, Germany.
    2. Brandon A. Kohrt & Laura Asher & Anvita Bhardwaj & Mina Fazel & Mark J. D. Jordans & Byamah B. Mutamba & Abhijit Nadkarni & Gloria A. Pedersen & Daisy R. Singla & Vikram Patel, 2018. "The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies," IJERPH, MDPI, vol. 15(6), pages 1-31, June.

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